This cohort study demonstrates, among individuals with negative baseline low-dose CT chest for lung cancer screening, a history of smoking ≥20 pack-years continues to portend increased lung cancer risk. Short-term smoking cessation (<15 years) does not meaningfully reduce this residual risk, especially in heavily exposed individuals, supporting continued surveillance despite a negative screen. Notably, there was higher risk among women than men at the same smoking exposure, as well as comparable risk for those ages 50 to 54 years with ≥30 pack-years as those older with ≥20 pack-years suggesting expanding screening eligibility to this high risk population. | Liu, JAMA Netw Open 2026
